Letter to the Editor by Rudd to “Opiate Crisis and Healthcare Reform in America: A Review for Nurses”

Healthcare Reform: Nurses Impact Policy

July 14, 2018

Response by Lisa Rudd to “Opiate Crisis and Healthcare Reform in America: A Review for Nurses” by Susan G. Painter (May 31, 2017)

With Reply from Author

Dear Editor:

I am writing in response to the column, “Opiate Crisis and Healthcare Reform in America: A Review for Nurses” (Painter, 2017). This article addresses the complex and multifaceted factors which have led to a crisis of epidemic proportions (Leahy, 2017). Nurses need to be aware of the significant role that they play in mediating support for patients with substance use disorders and for patients with a medical need for pain management with opioid medications (Painter, 2017).

The role of nurses in identifying patients with substance abuse disorders or those that are at risk has been largely undervalued and underutilized (Jungquist, Vallerand, Sicoutris, Kwon, & Polomano, 2017). Because nurses provide patient assessments upon admission, during their shift, and at discharge, they are in in position to first recognize substance abuse disorders in patients (Felicilda-Reynaldo, 2014). Nurses have a unique role in providing education to patients and being able to notify providers of potential issues with inadequate pain control or side effects of opioid administration education (Costello & Thompson, 2015).

Providers may be inclined to adopt overly restrictive prescribing of opioids in response to the current crisis; but, patients with a medical necessity for opioid use for effective pain management related to terminal illnesses, such as cancer, may not receive proper pain control based on these practices (Jackson, Imam, & Braun, 2017). Nurses should be advocates for patients by performing pain assessments throughout their shift and in reporting pain unrelieved by opioid administration to providers for further follow-up and coordination of care (Jungquist et al., 2017).

The nursing role involves both patient-nurse and nurse-provider interactions which have important influences in the screening, identification, and treatment of patients (Leahy, 2017). To be effective in their patient care role, nurses must identify barriers that may interfere with patient engagement and assessment related to substance abuse disorders such as a personal bias or stigma towards this patient population which can impact care on an emotional level (Harris & Yu, 2016). Nurses must have an open and positive attitude towards their patients to promote patient comfort in discussing substance use or abuse (Painter, 2017).

Nurses should commit to increasing their knowledge about addiction; proper and safe administration of opioids; and signs of substance abuse in their patients (Felicilda-Reynaldo, R., 2014). Nurses should also become familiar with resources, support networks, and treatment facilities in the community (Harris & Yu, 2016). Lastly, nurses should advocate for their patient’s pain management needs through proper pain assessment, medication administration, and communication (Jungquist et al., 2017).

In conclusion, the role of the nurse in addressing the opioid crisis must be acknowledged and put into practice by all nurses. The goal of nursing care is two-fold. First, nurses must provide support of patients with substance abuse disorders including identification and referral to resources and provider interventions. Secondly, nurses must provide support for patients with a medical necessity for using opioids by ensuring that they have proper pain control and management through collaboration with providers.


Lisa P. Rudd, RN, BSN
Wake Forest Baptist Health-Oncology
RN-BSN Student, UNC-Wilmington
Email: ruddlp@gmail.com


Costello, M., & Thompson, S. (2015). Preventing opioid misuse and potential abuse: The nurse's role in patient education. Pain Management Nursing, 16(4), 515-519. doi:10.1016/j.pmn.2014.09.008

Felicilda-Reynaldo, R. (2014). Recognizing signs of prescription drug abuse and addiction, part I. Medsurg Nursing, 23(6), 391-396.

Harris, B., & Yu, J. (2016). Attitudes, perceptions and practice of alcohol and drug screening, brief intervention and referral to treatment: a case study of New York State primary care physicians and non-physician providers. Public Health, 139, 70-78. doi:10.1016/j.puhe.2016.05.007

Jackson, L. K., Imam, S. N., & Braun, U. K. (2017). Opioids in cancer pain: Right or privilege? Journal of Oncology Practice, 13(9), e809-e814. doi:10.1200/jop.2016.019216

Jungquist, C. R., Vallerand, A. H., Sicoutris, C., Kwon, K. N., & Polomano, R. C. (2017). Assessing and Managing Acute Pain. AJN, American Journal of Nursing, 117, S4-S11. doi:10.1097/01.naj.0000513526.33816.0e

Leahy, L. G. (2017). The opioid epidemic: What does it mean for nurses? Journal of Psychosocial Nursing & Mental Health Services, 55(1), 18-23. doi:10.3928/02793695-20170119-03

Painter, S. G. (2017). Opiate crisis and healthcare reform in America: A review for nurses. OJIN: The Online Journal of Issues in Nursing, 22(2), Manuscript 3. Available: http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-22-2017/No2-May-2017/Opiate-Crisis-and-Healthcare-Reform-in-America.html